Suicidal thoughts and behaviors are a primary reason for psychiatric hospitalization for nearly 50% of hospitalized adolescents. Schools are one of the primary environments adolescents return to following hospitalization, making them a critical context for adolescent recovery from suicidal thoughts and behaviors. School stressors serve as important risk factors for both suicide and re-hospitalization, but, until now, have been overlooked by treatment interventions for suicidal adolescents. The primary goal of this K23 Career Development Award is to support the applicant to become an independent investigator advancing suicide prevention interventions that bridge two systems otherwise isolated ? psychiatric settings and schools. The specific training goals are tailored to support the applicant?s development as an intervention scientist: (1) build expertise in intelligent use of technology and instructional design to enhance interventions for high risk adolescents; (2) develop research skills to learn innovative designs and approaches for developing, optimizing, and evaluating interventions for suicidal adolescents; (3) gain knowledge of modifiable school variables and the affective and cognitive markers serving as mechanisms of change in adolescents with suicidal thoughts and behaviors and incorporate measures of these variables in intervention research; and (4) develop competency in ethical considerations for conducting research with high risk adolescent populations. The applicant will achieve these goals through applied experiences; mentor-based supervised training; formal graduate level coursework and short courses; and participation in research seminars, colloquia and scientific meetings. To ensure the attainment of these goals, the mentorship team includes senior level intervention researchers with expertise in novel methodologies applicable to suicide prevention: Drs. David Goldston, Dorothy Espelage, Robert Hubal, and David Wyrick. The proposed study aims to develop and refine a novel Virtual Reality (VR) supplement for inpatient treatment: the Practice Experiences for School Reintegration (PrESR) program. The PrESR will provide immersive school experiences for inpatient adolescents to practice skills in real-world settings with the guidance of a trained clinician within the confines of a hospital. The specific aims of the study, guided by a multiphasic optimization strategy (MOST) research design, include: (1) refine the PrESR model; (2) iteratively develop the PrESR to enhance cognitive behavioral therapy (CBT) skill practice during hospital stay; and (3) conduct a pilot optimization trial of the PrESR with CBT skills used during inpatient interventions to demonstrate (A) the potential of the PrESR to increase CBT skill acquisition and utilization and (B) the feasibility of training clinicians, recruiting participants, and managing experimental conditions. Consistent with NIMH?s priorities for suicide prevention, and for tailoring existing and new interventions to optimize outcomes, the PrESR aims to optimize the translation of learned skills into real life environments in order to prevent youth suicide.